Ca125

Serum levels of CA-125 loosely correlate with the volume of disease. Although there is controversy regarding the value of CA-125 before surgery as a predictor of survival, its role in assessment of treatment response is well established. Looking at the usefulness of the preoperative value of CA-125 in predicting optimal cytoreduction, it has been shown that preoperative CA-125 values of less than 500 U/mL had a positive predictive value for optimal cytoreduction of 82%, but a poor negative predictive value of 48%.58 In another study, the sensitivity of this test in predicting optimal cytoreduction was 58%, and the specificity was 54%.59 CA-125 levels have been shown to correlate with survival in patients receiving platinum-based chemotherapy. In a study of patients with suboptimally debulked stage III and IV ovarian cancer, the levels of this tumor marker 8 weeks after therapy was of significant prognostic value. The median survivals for patients with a CA-125 level of less than 35 U/mL compared with patients with a CA-125 level of more than 35 U/mL were 26 months and 15 months, respectively. Furthermore, women with serum CA-125 values less than 50% of their pretreatment concentration at 8 weeks experienced a median survival of 21 months compared with only 10 months for individuals with tumor marker levels above 50% of their baseline value.60

Table 1-6. Multiple Linear Regression Analysis

Variable

Change in Median Survival Time

95% CI or CL P

% Increase

Percent maximal cytoreduction 5.5 10% 3.3-7.8 <.001

Year of publication 2.8 1 year 0.9-4.6 .004

Cumulative platinum dose 1.4 1 U -1.9, 4.7 .377

CI, confidence Interval; CL, confidence limits.

Percent maximal cytoreduction 5.5 10% 3.3-7.8 <.001

Year of publication 2.8 1 year 0.9-4.6 .004

Cumulative platinum dose 1.4 1 U -1.9, 4.7 .377

CI, confidence Interval; CL, confidence limits.

From Bristow RE, Tomacruz RS, Armstrong DK, et al: Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20(5):1248-1259, 2002, Table 2.

The rate of decline in CA-125 during primary chemotherapy has been an important independent prognostic factor in several multivariate analyses. Data suggest that rapid normalization within 1 month of initiation of treatment is of major prognostic significance. Persistent elevation of CA-125 at the time of a second-look surgical surveillance procedure predicts residual disease with more than 95% specificity. Rising CA-125 values have preceded clinical detection of recurrent disease by at least 3 months, but not in all studies. Rising CA-125 during subsequent chemotherapy has been associated with progressive disease in more than 90% of cases.61

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